Provider Demographics
NPI:1336166818
Name:KINDSVATTER, LINDA LOU (OD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LOU
Last Name:KINDSVATTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:HOOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 JOINER ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2863
Mailing Address - Country:US
Mailing Address - Phone:802-488-0401
Mailing Address - Fax:
Practice Address - Street 1:1100 S PONCE DE LEON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6013
Practice Address - Country:US
Practice Address - Phone:904-231-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1693DT152W00000X
OH4758152W00000X
FL6657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66392Medicare UPIN
OHK10820473Medicare ID - Type Unspecified